This inspection was carried out on 4 April 2017 and was unannounced. At their last inspection on 20 January 2015, the service was found to be meeting the standards we inspected. However, activities for people living at the service required improvement. At this inspection we found that they had continued to meet all the standards and had improved activities for people living at the service.

Ashwood Place provides accommodation for up to eight people with physical and learning disabilities. At the time of the inspection there were eight people living there, however, one person was in hospital.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People indicated they felt safe at the service and there were individual risk assessments in place for people’s varying needs. Relatives told us they felt people were safe.

People were supported by sufficient numbers of staff who had been safely recruited, had received the appropriate training and felt supported. We found that medicines were managed safely.

People had their capacity assessed and where they were unable to make decisions independently, a best interest decision was recorded. There was appropriate support to maintain a healthy and balanced diet and there was regular contact with health and social care professionals.

People were treated with dignity and respect and had meaningful relationships with staff. We found that people and their relatives were involved in the planning and reviewing of their care. Confidentiality was promoted, however, staff needed to ensure the cupboard where records were stored was kept locked.

People received care that met their needs and their care plans were clear, up to date and person centred. The provision of activities for people had been improved and there were many more opportunities for people to do something they enjoyed. Complaints and concerns were responded to appropriately and this information was shared with staff.

The registered manager knew people well and was invested in providing good care to people. Staff at the service shared the registered manager’s views about what type of service they wanted to provide. There were effective quality assurance systems in place to identify and address any shortfalls.

The inspection was carried out on 20 January 2015 and was unannounced. At our previous inspections we identified a breach in relation to Regulation 10 Health and Social care Act 2008 (Regulated activities) Regulations 2010 as systems in place for monitoring and managing the quality of the service were not always effective. However, at this inspection we found that the required improvements had been made. Systems in place to assess and manage the quality of the service were in place and actions developed as a result of these systems were seen to be completed.

Ashwood Place is a care home which provides accommodation and personal care for up to eight people with learning and physical disabilities. At the time of our inspection there were eight people living at the home. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service and were pending an outcome. The manager and staff were familiar with their role in relation to MCA and DoLS.

People were receiving care that met their individual needs. Staff were clear on what support people needed and provided this in a timely manner. There was sufficient food and drink available and people were assisted to eat and drink in a calm and sensitive way.

There was access to visiting health and social care professionals. Staff responded to changing health needs and sought the appropriate guidance or care. Medicines were managed safely to ensure people received them in accordance with their needs.

Staff were clear on how to identify and report any concerns relating to a person’s safety and welfare. The manager took all concerns brought to them seriously.

Staff were recruited through a robust procedure and provided with regular training to ensure their knowledge was up to date. Staff were clear on what their role was and shared the manager’s views. The manager was a visible presence in the home and carried out regular monitoring of the service. This provided guidance and leadership for the staff team.

We set out to answer five questions. These were whether the service is caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service and the staff that supported them. We also spent time looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that care was planned and delivered in a way that was intended to ensure people’s safety and welfare.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Where applications had needed to be submitted, proper policies and procedures had been followed. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We found that the service had followed the appropriate process in relation to safeguarding people from the risk of abuse. Staff we spoke with were clear on how to identify and report concerns.

Is the service effective?

We saw that most of the risk assessments and support plans had been reviewed and updated monthly. We looked at the care notes for people whose plans we had viewed and saw that in most cases care was recorded as being delivered in accordance with the plans.

Is the service caring?

We observed staff interaction with people who used the service and noted that interactions were positive. Staff used appropriate forms of communication which was well received by people.

Is the service responsive?

We saw that the service responded appropriately to accidents and incidents. The manager then supported staff following this. This included additional training to ensure the continued improvements at the service. We saw that the manager addressed issues that we identified during our inspection straight away.

Is the service well led?

Staff we spoke with told us that the manager was knowledgeable and they felt supported. We saw that in the manager had reviewed most areas of the home. However, we noted that these were not always followed up. We spoke with the manager who was clear on how to manage outstanding issues. We noted that the manager had only been in post for four months at the service and was working through various areas that they had identified.

When we inspected Ashwood Place on 12 December 2013, we found that the service did not have effective systems in place for the management and prevention of pressure ulcers.

At our inspection on 28 February 2014 we found that the service had now assessed and planned for people's pressure care prevention effectively. We saw that pressure care prevention was now being delivered and staff member's knowledge in this area had improved.

We inspected Ashwood Place on 13 September 2013 and found that people who used the service did not have their needs assessed in relation to pressure care. This meant that their care was not planned or delivered in accordance with their individual needs. We also found that people's medicines were not being recorded and administered in accordance with the prescriber’s instructions.

We carried out a further inspection on 12 December 2013.We found that, although there had been some improvement to the way in which people’s needs were assessed, this was still not planned or delivered in accordance with a person’s individual risk in relation to pressure care.

People were protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines.

At our inspection on 15 May 2013 we found that people’s privacy and dignity was not always respected. We found that people weren’t supported appropriately to ensure they received sufficient nutrition and hydration.

We saw that people who used the service had not been assessed for risks associated with pressure care.

We looked at management of medication and found there were gaps in the documentation of medication. We saw that the required standards in relation to the handling and safe storage of medication were not being met.

At our inspection on 13 September 2013 we saw that improvements had been made and people’s privacy was respected. We saw that people were receiving the appropriate support and interventions where needed in relation to nutrition and hydration.

However, we looked at three people’s care plans and we saw that people still did not have their care assessed and delivered appropriately. We found that staff did not have the necessary knowledge to support people safely in relation to pressure care.

There were gaps in the documentation of medication and the required standards in relation to the handling and safe storage of medication were still not being met.

During our inspection we observed some practice that did not promote people's privacy and dignity.

We looked at peoples care plans and found that these were in place in relation to personal care. We spoke with visiting health and social care professionals who told us that they thought the care provided was good. One person told us, "End of life care is perfect." However, we found that assessments and plans were not in place to maintain skin integrity.

As the service provided people with assistance with eating and drinking we observed mealtimes. We saw that lunchtime was pleasant and relaxed. However, we found that the systems in place were insufficient to monitor and promote adequate nutritional intake.

We looked at medication and found that there were areas that needed to be improved in relation to safely recording medication.

As part of our inspection we looked at staffing levels including how staff were supported and trained. We found that the staff numbers were consistent and they received regular training updates. We were told by a relative of a person who used the service that there was a low staff turnover. They told us, "They are well equipped to do the job."

Not all of the people living at Ashwood Place could communicate verbally with us. One person we spoke with said “I like it here”. Another person told us that the home was “very nice" and that they felt safe.

Relatives of people living there spoke very positively about the home and staff. One relative said “They are respectful of my relative’s property and privacy; it’s like walking into your own home. It is an excellent service.” Another relative spoke very positively about their involvement in care planning and said “I get a copy of my relative’s care plan; I see it annually and get the chance to contribute to it. The people working there seem to have a good ethos about the standard of care.” Another relative told us: “A great facility – a high level of staff care.”

Relatives of people using this service told us that they could visit whenever they wanted to and that they felt the home was safe. One person told us that they were welcome to go into their relative’s room when visiting and that the staff would often partition off a private area for them if they wanted some privacy during their visit. Another person said “There is a good level of safety. We met the manager and deputy who seemed to have a lot of expertise in dementia."